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The letter below is self explanatory. I am forwarding it to the list (with Ms Spanker's knowledge and approval) and have undertaken to forward to her any response you good folks may care to make. Dennis. +++++++++++++++++++++++++++ Dennis Greene 50/dx 37/ onset 32 There's nothing wrong with me that dealing with PD won't fix! email - [log in to unmask] Website - http://members.networx.net.au/~dennisg/ (most recent update -Nov 5, 1999) +++++++++++++++++++++++++++ Dear Mr. Greene, I've been enjoying your website. In particular, it helps me better understand the nature of the disease and the "real" ways it affects a person's life. I have a question I hope you may be able to answer. From what you know of the disease generally, what, if anything are the cognitive effects of Parkinson's ? Stuff I read sometimes says "no effect identified ", or says "not in the early stages...". What's the scoop? The reason I ask, has to do with a legal case I was analysing for our law commission last year. It was describing the ways that the law is involved in "older adults' personal relationships." In this particular Canadian case, a husband and wife ( Mr. and Mrs. S. ) went to a major health clinic to have his condition assessed (his condition had been deteriorating). They lived out in the country, and the clinic was in the city. Mr. and Mrs. S. were in their late 70s. Mr. S. has had Parkinson's disease for at least 20 years, and a bunch of other health problems more recently. At the health clinic, the doctor in charge wants to put a "do not resuscitate order" (DNR) on Mr.S.'s chart. Mrs. S. was adamantly against this. The Dr. backs off for the moment. [ Normally you ask patients what they want in terms of treatment, none treatment, as long as they are mentally competent. If they are not, they you normally go to their "proxy" or "substitute decision maker" At this time, Mr. S. has a lot of trouble communicating because of the Parkinson's disease. In the following months, the Dr. continues to try to persuade Mrs. S. that there should be a "DNR" order for her husband. [little mention in the case of whether or how hard the doctor tried talking with Mr. S.] Later, doctors orders a tracheostomy-- now Mr. S. can't communicate his wishes at all. Mrs. S. objects to that operation too. Doctors "leap frog" her-- and they go to the Public Trustee to have a protective order placed on Mr. S.-- now they don't have to talk to Mrs. S. at all. A DNR order is placed on the chart. Mrs. S. goes to court to get an injunction to get the DNR order removed from her husband's chart. Mrs. S. spends countless hours a day at hospital with her husband and says-- " listen I spend all this time with my husband, I can communicate with him and I know what he wants. " Doctors and nurses basically suggest "you are silly old woman who really haven't come to terms with your husband's condition. He can't communicate with you or he doesn't understand what's going on ...You are just afraid of being alone... We know what's best for him and he should not be resuscitated if he goes into cardiac arrest" (I'm paraphrasing and editorializing).. The Issues This case really bothers me for a lot of reasons-- I really see a lot of older people's rights being trounced upon in health care because they are seen as "less valuable" or "not worth the effort". Mr. S. was ignored in this whole process-- doctors appear to have assumed he was not mentally capable of expressing his wishes, largely because he could not communicate; so they leapfrogged over him and went to his wife; and when she didn't give them the answer they wanted, they leapfrogged over her to go the Public Trustee, who basically said to the doctors "You decide what's best"... But that brings me back to my question : From what you know of the disease generally, what, if anything are the cognitive effects of Parkinson's disease on the person? Does it leave some people mentally impaired at some stage. Or are the thoughts still in there and they can't get out? I'm wondering if the one of classic signs of Parkinson's ( blank expression) could easily be misread as "not being all there." Charmaine Spencer Gerontology Research Centre Simon Fraser University 2800-515 West Hastings Street Vancouver, B.C. p: 1-604-291-5047 f: 1- 604-291-5066 email: [log in to unmask]